颈前路钩椎关节减压联合改良植骨术治疗颈椎病

Uncinate decompression and modified bone graft technique for anterior cervical surgery

中文关键词:  颈椎病  钩椎关节减压  混合植骨方式  脊柱融合

英文关键词:Cervical spondylosis  Uncinate decompression  Mixture bone graft method  Spinal fusion

中文摘要:

  【摘要】 目的：比较钩椎关节减压改良植骨术和常规颈前路椎体次全切除自体髂骨移植融合术治疗颈椎病的疗效。方法：回顾性分析2008年7月～2009年6月收治的137例连续两个节段受压的颈椎病患者，按治疗方法分为两组，A组61例采用颈前路单椎体次全切除钩椎关节减压+填充自体碎骨的异体腓骨支撑植骨+椎间隙四角局部自体骨移植+颈前路钢板内固定的方法进行治疗。B组76例，采用传统颈椎前路椎体次全切除自体髂骨移植术治疗。比较两组患者围手术期情况（住院天数、手术时间、出血量、并发症）、临床疗效（NDI、VAS评分）及影像学结果（手术节段高度、弧度及融合率）。结果：A组手术切除节段1例在C3，15例在C4，26例在C5，19例在C6；B组手术切除节段1例在C3，23例在C4，32例在C5，20例在C6。A组手术时间（103.6±21.7min）和术后住院天数（3.0±0.8d）及围手术区并发症发生率（9.8％）明显低于B组（分别为147.4±28.3min、5.2±1.1d和25.0％）（P<0.05）；A组术中出血量（182.7±46.4ml）小于B组（227.7±42.2ml），但两组差异无显著性（P>0.05）；两组患者术前术后NDI及VAS评分无显著性差异，单纯分析混合型颈椎病和神经根型颈椎病患者A组疗效优于B组；两组手术节段弧度及高度无明显差异；A组58/61例（95.1%）融合，B组76/76例（100%）融合，差异无统计学意义，B组术后10例出现供骨区血肿，1例感染。结论：颈椎前路钩椎关节减压改良植骨术与传统颈前路椎体次全切除自体髂骨植骨术在临床疗效及术后融合率方面无显著性差异，但前者更适用于伴有神经根管狭窄的神经根型颈椎病或者混合型颈椎病，且可显著缩短手术时间、术后住院天数并降低围手术期并发症发生率。

英文摘要:

  【Abstract】 Objective：The study was undertaken to compare the outcomes of uncinate decompression and modified bone graft（UDMBG） technique with routine anterior corpectomy and fusion（RACF） in anterior cervical surgery.Method：A total of 137 patients who underwent surgical treatment for 2-level cervical spondylosis from July 2008 to June 2009 were reviewed.They were divided into two groups according to the operation methods.There were 61 patients（35 men，26 women，age 41-82 years） in group A，who underwent uncinate decompressions and used allo-fibula strut filled with local auto-bone dust and local cancellous chunks of corpectomy bone placed into the decorticated uncinate regions bilaterally.There were 76 patients（47 men，29 women，age 40-78 years） in group B，who underwent RACF with iliac crest autograft.All patients were fixed with semi-rigid plates.Perioperation parameters（days of hospital stay，operation time，bleeding amount，complication rate），fuctional parameters（NDI，VAS scores），and radiologic parameters（segmental height，cervical lordosis，arthrodesis rate） were compared.Result：There were 1 C3，15 C4，26 C5，19 C6 corpectomies in group A and 1 C3，23 C4，32 C5，20 C6 corpectomies in group B.Operation time，days of hospital stay and perioperation complication rate were significantly lower in the group A（P<0.05）.There was no significant difference for the bleeding amount and the improvement of NDI and VAS between two groups.Group A has a better result for the radiculopathy and mixed cervical spondylosis.The segmental height and the Cobb angles were similar.58 cases（95.1%） fused in group A and 76 cases（100%） in group B at 1 year postoperation，without statistical difference.10 cases of hematoma and 1 case of infection after iliac bone harvest were found in group B.Conclusion：UDMBG and RACF were found to be similar in clinical outcomes and radiologic parameters.However，UDMBG decrease operative time，days of hospital stay and complication rate significantly.This modified surgical procedure applies to radiculopathy and mixed cervical spondylosis accompanied with neural foraminotomy stenosis.